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10.1371/journal.pgph.0003682
PGPH-D-23-01362
Research Article
Medicine and Health Sciences
Critical Care and Emergency Medicine
Trauma Medicine
Traumatic Injury
Burns
Medicine and Health Sciences
Dermatology
Burn Management
People and Places
Geographical Locations
Africa
Ethiopia
Physical Sciences
Chemistry
Electrochemistry
Electrolytes
People and Places
Population Groupings
Ethnicities
African People
Amhara People
Medicine and Health Sciences
Critical Care and Emergency Medicine
Trauma Medicine
Traumatic Injury
Medicine and Health Sciences
Health Care
Health Care Facilities
Hospitals
Medicine and Health Sciences
Health Care
Health Statistics
Morbidity
Outcome of burn injury and its associated factors among burn patients attending public hospitals in North Showa Zone, Ethiopia: A cross-sectional study
Outcome of burn injury and its associated factors among burn patients attending
Shewaye Ejigu Mulugeta Conceptualization Data curation Formal analysis Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – review & editing 1
Abosetugn Akine Eshete Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 1
https://orcid.org/0000-0001-8126-6086
Getnet Mekasha Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 2
Minda Dr. Abebe Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 1
https://orcid.org/0000-0002-6054-9068
Ayele Abebe Nigussie Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 3 *
https://orcid.org/0000-0001-7787-6949
Tefera Mitiku Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 4
1 Departments of Public health, Debre Berhan University, Asrat Woldeyes Health Science Campus, Debre Berhan, Ethiopia
2 Department of Nursing, Debre Berhan University, Asrate Woldeyes Health Science Campus, Debre Berhan, Ethiopia
3 Department of Pediatrics Nursing, Debre Berhan University, Asrate Woldeyes Health Science Campus, Debre Berhan, Ethiopia
4 Department of Midwifery, Debre Berhan Health Science College, Debre Berhan, Ethiopia
Alayande Barnabas Tobi Editor
University of Global Health Equity, RWANDA
The authors declare that they have no competing interests exist.

* E-mail: abebe2014nigussie@gmail.com
16 9 2024
2024
4 9 e00036822 8 2023
8 8 2024
© 2024 Shewaye et al
2024
Shewaye et al
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Burn injury is a major contributor to morbidity and mortality in developing countries. In Ethiopia, the outcome of burn injuries and associated factors among burn patients were not clearly described. To assess the outcome of burn injuries and its associated factors among burn patients attending public hospitals in the North, showa Zone, Ethiopia. An institution-based cross-sectional study was conducted among 420 burn patients in public hospitals of the North showa, zone. Systematic random sampling was used to select study participants. Structured checklists were used to extract data from burn patients’ medical records. Data was entered using Epi-Data version 4.6. Data was analyzed using SPSS version 25. A p- value of ≤ 0.05 in the multivariable logistic regression was used to declare a significant association. In this study, the prevalence of discharges with complications was 40.9% (95% CI: 36.5–45.6). The odds of developing complications among patients having pre-hospital intervention were nearly four times the odds of not having the intervention (AOR = 3.8, 95% CI, 1.11–13.25). The odds of developing complications among patients having scalds were four times the odds of not having scalds (AOR = 4.3, 95% CI, 1.52–12.32). A patient who received fluid and electrolytes was 76% less likely to develop the outcome of burn injury discharged with burn complications. Patients with TBSA less than 20% were 66% less likely to be discharged with complications compared to patients with TBSA greater than 20%.: This study demonstrates a significantly higher level of outcome for patients with burn injuries who were discharged with complications, leading to death and other bad outcomes. Therefore, stakeholder would more emphasis in health education on prevention of burn injuries, first aid treatment of burn, treatment of the cause of burns, and providing fluid and electrolytes.

The authors received no specific funding for this work. Data AvailabilityAll data are available in the manuscript and supporting file.
Data Availability

All data are available in the manuscript and supporting file.
==== Body
pmcIntroduction

Burn is a term used to describe skin and tissue damage brought on by a fire, scald, electrical shock, chemical burn, or radioactive radiation. Due to the prolonged hospitalization for rehabilitation and the treatment of wounds and scars, burns are the most expensive traumatic injuries [1]. Large burn victims have many of the same physiological reactions as victims of major trauma, particularly venous thromboembolism [2]. It is one of the most frequent and unpleasant forms of trauma, in addition to being a substantial worldwide health problem that increases morbidity and death and causes significant material, psychological, and financial damage [3]. Burn-related wounds are damaging injuries that are linked to morbidity, a reduction in quality of life, and emotional well-being [4]. Mortality and morbidity from burns remain high, particularly in developing countries [5]. These areas are also areas where the lack of socio-economic growth, and geopolitical instability create additional barriers not only to the delivery of health care but also to the acquisition of continuous professional development [6]. Burns are estimated to be the root cause of 180,000 deaths worldwide, most of which currently occurs in low- and middle-income countries [7]. Burns are the fourth-leading cause of trauma in the world and are common in developing countries [8]. Burn injury incidence and mortality affect all regions of the world, but are most concentrated in LMICs [9]. Burns are a major public health problem worldwide [10]. The fatality rate for child burn victims in Africa was 27.8% [11].

A study shows that the magnitude of burns with complications in Ethiopia was 14.9%. The highest risk groups were children and older age groups compared to adults [12]. In almost all age groups, the prevalence of burns is higher in women [13]. The increase in burn risk in 3rd degree burns was more likely in cases of wound infection, and the risk of such infection was also considered in burn surgery [14]. Wound infection and septicemia were the two most common complications in burn patients [15]. A burn injury contains both nociceptive and neuropathic pain components, so managing a person who suffers from a burn injury is one of the most difficult challenges for first responders [16]. Treating a burn requires many hours of wound care by nursing staff, possibly multiple surgical procedures, and expensive hospitalization [17]. Burns are the most painful, require special attention, and are considered a major public health problem [18]. Burns are the fourth most common type of trauma causing death and disability after traffic accidents, falls, and interpersonal violence [19]. Globally, burns are one of the leading causes of disability, accounting for more than 8 million disability-adjusted life years (DALYs) [20]. In South Africa, an estimate of US$26 million is spent annually on burn injuries, but indirect costs such as lost wages, long-term treatment for disfigurement and emotional trauma, and the contribution of family resources also indirectly contribute to socioeconomic impacts [21]. Currently, most burn centers around the world care for patients based on a protocol of burn management, like emergency phase management, acute wound care, and rehabilitation modalities [22].

In the 20th century, advances in burn care led to an increased focus on reducing burn morbidity [23]. Burns often result in significant psychological, educational, and social stigma, and the resulting changes are exacerbated by many factors, including the circumstances of the burn, the severity and location of the injury, the personality characteristics of the injured person, access to supportive interpersonal communication, and social relations [24]. Both the patients and their families may experience physical and emotional suffering as a result of the burns and treatment [25]. Burns are the second most common injury in rural Nepal, accounting for 5% of hospital admissions [7]. It is estimated that over a million people in Africa each year, and 18% of hospitalizations are due to burns [26]. Burns are a common source of harm in developing countries, including Ethiopia [27]. The incidence of burns varies by country and population group, and the severity of the burn depends on the degree of heat, duration of exposure, and thickness of the skin [28]. Burns occur mainly at home and in the workplace, as in Bangladesh and Ethiopia, which show that 80–90% of burns occur at home [29]. In Ethiopia, the outcome of burn injuries and associated factors among burn patients were not described. Hence, it needs more study to assess the possible outcome of burns and support a uniform treatment protocol in health facilities. Therefore, this study assessed the outcome of burn injuries and their associated factors in a public hospital in North Shewa Zone, Amhara regional state, Ethiopia.

Methods

Ethical statement

Ethical approval and clearance were obtained from the institutional review board (IRB) of Asrat Woldeyes Health Science Campus. Permission was obtained from the Zonal Health Office and the selected hospital chief executive officer. All aspects of basic ethical research principles were addressed, so the study participants were selected based on the research requirements. The study participant’s name was not written in the questionnaire’s form and will never be used in connection with any information you tell us. All information given by the study participant was kept strictly confidential. Codes and aggregate reporting were used to eliminate names and other personal identifiers of respondents throughout the study process to ensure anonymity.

Study design, setting and period

An institution-based cross-sectional study was conducted among 420 burn patients in a public hospital in the North Showa Zone, Northeast Ethiopia, from April to May in, 2023. Debre Berhan City is located 130 kilometers from Addis Ababa, the capital city of Ethiopia, and 696 kilometers from Bahirdar, north east, the regional state of Amhara. The total population of North Showa Zone was 2,322,148, of whom 1,171,510 were men and 1,150,638 were women in 2019. According to the Zonal Health Office Report, North Shewa has 164 private clinics, 97 governmental health centers, 391 health posts, 8 primary hospitals, of which two are private primary hospitals, 2 general hospitals, and one comprehensive specialized hospital. North Shewa Zone has a total of 10 public and 2 private hospitals.

Study population

All burn patients who attended burn clinics have medical record folders in selected public hospitals from January 1st, 2018 to December 30th, 2022, in the North Showa Zone, Amhara, Ethiopia.

Inclusion and exclusion criteria

Inclusion criteria

All burn patients who attended North Shewa Zone Public Hospital registered on patient cards or medical record folders in the hospital, and whose card or record was available in the medical record unit or card room, were included.

Exclusion criteria

Burn patients with incomplete records or information on either the burn or missed diagnosis upon review were excluded from the study.

Sample size determination and sampling techniques

The sample size for this study was determined by single-population formulas. Sample size was calculated using the prevalence of burn injury (p = 54.7%) [12], with a 5% margin of error, a 95% CI, and a 10% non-response rate were considered. By adding a 10% non-response rate, the total sample size becomes 420.

There are 10 public hospitals in the North Showa Zone; from these, five were selected using a simple random sampling method. The medical record numbers (MRN) of the burn patient were used as a sampling frame. The sample was allocated proportionally to each hospital. Study participants were selected using a systematic random sampling technique. First, determine the sampling interval (K) value by dividing the total admitted burn patients in the study period by the total sample size, which gives 2.17 ≈ 2, as shown in (Fig 1).

10.1371/journal.pgph.0003682.g001 Fig 1 Schematic presentation of sampling procedure for a study on the outcome of burn injury and its associated factors among burn patient at public hospital in North Shewa Zone, 2023.

Variables

Our dependent is outcome of burn injury discharge with complication or without complication. The independent variables are socio-demographic factors, health factors and clinical factors. These variables are described in conceptual frame work as shown in (Fig 2).

10.1371/journal.pgph.0003682.g002 Fig 2 Conceptual frame work for a study on the outcome of burn injury and its associated factors among burn patient at public hospital in North Shewa Zone, 2023.

Operational definitions

Discharge with complications

In this study, the patients have been discharged with one of the following: contracture, disfigurement, amputation, scar of skin graft, or death, as reported on the chart, which is considered a poor outcome of burn injury.

Burn patients

A patient who sustained a burn injury.

Burn injury

An injury to the skin or other tissue caused by thermal, radiation, chemical, or electrical [30].

Type of burn injury. Classified by depth of skin layers as superficial, deep partial thickness, full thickness, and total body surface area burned is involved.

Outcome of burn injury

After the patients admitted to the hospital are diagnosed as discharged with or without complications, as described by physician that reported in chart [31].

Data collection procedures

Data were collected using a structured checklist adopted from national burn patients’ medical record formats (patient cards) available in the medical record unit of the public hospital in the North Shewa Zone. All charts of burn patients diagnosed with burn injuries between January 1st, 2018 and December 30th, 2022, at a selective public hospital in the North Shewa Zone were reviewed from patient registries. The checklists were well prepared in the English language, a language in which burn patients’ medical records or patient cards were written. It contains information on socio-demographic conditions, clinical factors, and health-related factors. Data were extracted from the patient’s medical record via record review.

Data quality control and assurance management

A pre-test was done on 5% of the study samples at Hakim Gizaw Hospital, which is assumed to have similar characteristics to the study area. After the pre-test, necessary corrections were made to the checklist to amend language translation errors and the coherence of the checklist. Close supervision was conducted by the principal investigator and one MPH in epidemiology expert who had experience in the study setting. Data collectors and supervisors were trained on ethics, data collection tools, and how to review medical records and handle the patient card itself. Data collection is well supervised on a daily basis. Filled data were checked daily by supervisors and the principal investigator to minimize the errors that were created during the review as early as possible. Data collectors reviewed recorded cards in a separate place to keep privacy and confidentiality information.

Data analysis procedures

The collected data were checked manually for incompleteness and inconsistency. Data were entered using Epi-Data version 4.6 and analyzed using SPSS version 26. Descriptive statistics (frequency and percentage) for categorical predictors were done. The statistical association between each independent variable and the dependent variable was assessed using bivariable logistic regression. In the bivariable analysis, a predictor with a P-value<0.25 was considered for the multivariable analysis. The goodness of fitness was assessed by a Hosmer-Lemeshow test that was not significant (0.212). The colinearity among independent variables was assessed by the variance inflation factor (1–2.5); those variables with a VIF of less than 10 were considered to have no multi-colinearity. A multivariable logistic regression analysis was conducted to identify factors significantly associated with the outcome of burn injuries. The significance of the association was declared at a p-value of ≤ 0.05 within the 95% CI.

Result

Socio-demographic characteristics

A total of 408 participants participated, with a response rate of 97%. Among 408 participants, 44.9% were male. From the total of study participants, 68.3% were single, and 30.1% were married. Most of them were government employees and students. Most of the participants were at home when the burn happened, as seen in "(Table 1)."

10.1371/journal.pgph.0003682.t001 Table 1 Socio-demography characteristics of participants at public Hospitals in North Shewa Zone, Amhara Region, Ethiopia, in 2023 (n = 408).

Variables	Category	Frequency	Percent	
Sex	Male	183	44.9	
Female	225	55.1	
Age of participant	≤15 year	208	51.0	
16–40 year	174	42.6	
≥41 year	26	6.4	
Marital status(n = 252)	Single	172	68.3	
Married	75	30.1	
Widowed	5	1.6	
Occupation(n = 254)	Government employed	54	21.5	
Non-governmental organization	44	17.5	
Merchant	27	10.8	
Farmer	28	11.6	
Daily laborer	5	1.6	
House wife	41	16.3	
Student	52	20.7	
Where a patient was found when burn occurred	Home	365	89.5	
Street	8	2	
School	28	6.9	
Work place	7	1.7	

Health related factors

In this study, the main circumstances of surrounding burn participants were through accident (98.8%) and the remaining was by assault (1.8%). Most of the participants had superficial thickness burns (71.6%), 27.5% had partial thickness burns, and only 1% had full thickness burn injuries. Some participants (5.1%) had comorbidities with epilepsy. Among the study participants, 11.3% had pre-hospital interventions described as "(Table 2)".

10.1371/journal.pgph.0003682.t002 Table 2 Health-related factors of participants at public hospitals in the North Shewa Zone, Amhara Region, Ethiopia, in 2023 (n = 408).

Variables	Category	Frequency	Percent	
The main circumstance of surrounding burn	Accident	403	98.8	
Assault	5	1.8	
How was the depth of burn injury	Superficial	292	71.6	
Partial thickness	107	27.5	
Full thickness	9	1	
How much body part affected via burn	≤20%	319	79	
≥21%	89	21	
Were your neck and head affected	Yes	168	57.6	
No	240	42.4	
Were your upper extremity affected	Yes	161	39.4	
No	247	60.6	
Were your lower extremity affected	Yes	64	15.7	
No	344	84.3	
Were your anterior trunk affected	Yes	9	2.2	
No	399	97.8	
Were you have comorbidity (Epilepsy)	Yes	21	5.1	
No	387	94.9	
Were you have pre- hospital intervention	Yes	42	11.3	
No	362	88.7	

Clinical characteristics of participants

Of the participants admitted to the hospital, 75.2% were staying less than fifteen days. During hospital stay, 22.1% participants took fluid and electrolyte. 22.3% had wound management, and most of them used antibiotics. From the participant’s outcomes of burn injury with complications, 15.1% had disability, 20.5% had died, and 64.4% had been scarred, as shown in "(Table 3)".

10.1371/journal.pgph.0003682.t003 Table 3 Clinical factors of participants at public hospital in the North Shewa Zone, Amhara Region, Ethiopia, in 2023 (n = 408).

Variables	Category	Frequency	Percent	
Used fluid and electrolyte	Yes	90	22.1	
No	318	77.9	
Used burn wound management	Yes	91	22.3	
No	317	77.7	
Used antibiotic	Yes	370	90.7	
No	38	9.3	
Used pain management	Yes	326	79.9	
No	82	20.1	
Length of stay in hospital (n = 303)	≤ 15day	228	75.2	
16–25 day	25	8.3	
≥26 day	50	16.5	
If burn outcome with complication (n = 146)	Death	30	20.5	
Disability	22	15.1	
Scaring	94	64.4	

Cause of burn

This study showed that flame (35.5%) was the most common cause of burn injury, hot liquids (27.8%) were the second cause of burn, steam (13.2%) was the third, chemical (10.7%) burn was the fourth, and electrical (12.8%) was the last cause of burn, as seen in”(Fig 3)”.

10.1371/journal.pgph.0003682.g003 Fig 3 Schematic presentation of cause of burn among burn patients attending at public Hospitals in North Shewa Zone Amhara Region Ethiopia 2023 (n = 408).

Outcome of burn injury

In the study, the proportion of the outcome of burn injury discharged with complications was 40.9% (95% CI: 36.5–45.6), as seen in "(Fig 4)". The main adverse complications of burn injury were 12 (8%) deaths, 22 (15.3%) disabilities, and 112 (76.7%) contractures.

10.1371/journal.pgph.0003682.g004 Fig 4 Schematic presentation of the proportion on poor outcome among burn patients attending at public Hospitals in north Shewa Zone Amhara Region Ethiopia 2023 (n = 408).

Multivariate logistic regression

The odds of developing complications among patients having pre-hospital intervention were nearly four times the odds of did not have the intervention (AOR = 3.8, 95% CI, 1.11–13.25). Similarity, the study reveals that the odds of developing complications among patients with scalds were four times the odds of did not have scalds (AOR = 4.3, 95% CI, 1.52–12.32).

Patients who had provided fluid and electrolyte were 76% less likely to experience the outcome of burn injury discharged with complications than patients who had not used fluid and electrolyte (AOR = 0.24, 95%CI, 0.10–0.56). Similarly, the occurrence of total body surface area (TBS) less than twenty percent burned was 66% less likely to affect the outcome of burn injury discharged with complications compared to patient’s whose total body surface area burned greater than twenty-one percent (AOR = 0.34, 95%CI, 0.14–0.82), as shown in Table 4.

10.1371/journal.pgph.0003682.t004 Table 4 Bi-variable and multivariable logistic regression on outcome of burn injury among burn patients attending public hospital in North Shewa Zone, Amhara Region, Ethiopia, in 2023(n = 408).

Variables	Outcome of burn injury	
		COR (95% CI)	AOR(95% CI)	P-value	
Age of participant	≤15 year	128 80	1.86(1.82–4.23)	2.57(2.52–12.59)	0.24	
16–40 year	101 73	1.6(1.70–3.69)	3.52(4.75–16.35)	0.10	
≥41 year	12 14	1			
Length of hospital stay	≤15 day	117 111	0.59(2.31–4.11)	0.72(1.35–3.49)	0.38	
16–25 day	20 5	2.25(1.72–7.01)	2.28(1.64–8.14)	0.20	
≥ 26 day	32 18	1			
What was the main cause of burn injury	Flame	92 51	1.80(1.94–3.42)	1.13(1.55–3.46)	0.49	
Scald	73 38	1.94(1.99–3.80)	4.33(1.52–12.32)	0.006*	
Steam	25 29	0.82(1.38–2.78)	1.80(1.50–6.49)	0.36	
Chemical	21 22	0.95(1.42–2.14)	0.62(1.18–2.08)	0.44	
Electrical	26 26	1			
TBS in %	≤20%	42 40	0.62(1.38–2.06)	0.34(1.14–2.82)	0.017*	
≥21	199 118	1			
Sex of participants	Male	114 69	1.2(1.85–1.89)	1.17(1.65–2.09)	0.58	
Female	127 98	1			
Did you used antibiotic	Yes	214 156	0.55(1.26–3.16)	0.56(1.16–3.90)	0.35	
No	27 11	1			
Did you used fluid and electrolyte	Yes	37 53	0.39(1.24–2.62)	0.24(1.10–3.56)	0.001*	
No	204 114	1			
Did you have pre-hospital intervention	Yes	19 22	0.57(2.30–3.09)	3.84(2.11–7.25)	0.033*	
No	218 145	1			
Was your lower extremity affected	Yes	42 23	1.32(1.76–2.29)	3.38(1.96–9.88)	0.29	
No	199 144	1			
Was your upper extremity affected	Yes	128 107	0.66(2.44–5.99)	0.98(3.48–6.00)	0.96	
No	113 60	1			
Did you have co-morbidity(Epilepsy)	Yes	15 6	1.78(1.67–4.68)	0.71(1.17–2.98)	0.64	
No	226 161	1			
COR = Crude odd ratio, AOR = Adjusted odd ratio, CI = confidence interval

Discussion

In this study, 40.9% (95% CI: 36.5–45.6) had the outcome of a burn injury discharged with complications. Having pre-hospital intervention, patients with scald burn, early fluid and electrolyte provided, and having a total body surface area <20% were significant factors associated with discharge with complications. The result of this finding was higher as compared to studies in Ayder referral hospital, Mekelle city, Tigria regional state, and Addis Abeba Yekatit 12 hospital, Ethiopia, where 13.3% and 17.3% had poor outcomes for burn injuries [13, 31]. The possible reason might be due to the difference study area, study period variation, and small sample size. In another similar study in Addis Ababa burn, emergency, and trauma hospitals, only 14.2% were discharged with complications [12]. The difference might be that in the burn, emergency, and trauma hospitals, there was more sophisticated equipment in the emergency intensive care unit, enough emergency care health professionals, and well-equipped infrastructure at health institutions specifically for burn injury patients. This might be a reason for the low proportion of burned patients with the outcome of burn injury discharged with complications. But this finding is consistent with a study done at Haromia University [32]. Other studies conducted in Tanzania and Nepal revealed different results [33, 34].

The reason might be due to study population, area of study, study period, and time of data collection. In this study, the most frequent cause of injury is flame, which accounts for 35.5%, followed by scalds, steam, electrical, and chemical burns. The result of this study is consistent with studies done in Gonder, Ethiopia, and Tanzania [33, 35]. But this study contradicts studies in Addis Ababa Burn, Emergency, and Trauma Hospital, Ayder Referral Hospital, and Mekelle City [12, 31]. The possible justification might be due to population distribution by study population and socio-economic variation between populations. In this study, flame burn is the number one cause for the study population, followed by scalds, steams, electrical, and chemical burns.

In this finding, the affected body surface area (TBSA) burned due to the burn injury is an important feature in the determination of the burn injury. From the study participants, 79% of patients had a burn extent of less than 21% of TBSA. Findings of this study revealed that the occurrence of TBAS areas less than twenty percent burned were 66% less likely to discharge with compilation as compared to patients whose TBAS areas burned more than twenty-one percent. Which is in line with the study shown in Bahir Dar [13]. This results in a decline in intravascular hypervolemia, which can produce complications like ischemia in body organs. Similarly, patients who had received fluid and electrolyte were 76% less likely to suffer a burn injury discharged with complications than patients who had not used fluid and electrolyte during their hospital stay. The finding is also consistent with the study done in Ayder Referral Hospital, Mekelle City [31]. This could implicate that increasing public awareness regarding health-seeking behavior and early admission for intravenous infusion can diminish complications. This suggests that patients established timely supportive interventions related to fluid and electrolyte, resulting in fewer burn complications The odds of developing complications among patients having pre-hospital intervention were nearly four times the odds of did not have the intervention. This finding was not consistent with studies conducted in Haromia and Tanzania [32, 33]. The reason might be due to the difference in preexisting medical conditions before arriving at a health institution, the extent and depth of burn injuries, cultural traditions among burn management, and the quality of care in the community. The odds of developing complications among patients with scalds were more than four times the odds of did not have scalds. This finding is supported by a study conducted in South Gondar Zone government hospitals in Ethiopia [35]. But this result is different from a study done at Buganda Medical Centre in Northwestern Tanzania that showed flame, electrical, and chemical burns were more likely to cause complications as compared to scald burns [33]. The difference might be due to large sample size, life style, and socio-economic status because of those factors, which are prone to different burn injuries.

Recommendation

The health care workers place mainly emphasis on encouraging health education on pre-hospital intervention to prevent and perform initial intervention for patients with burn injuries. Increase the awareness and impact of scald burns for clients as well as the community. And also focus on providing fluid and electrolytes for patients who need hospital admission, and their total body surface area is affected by more than twenty percent. The researcher might do further case control studies as well as longitudinal studies that determine the association between risk factors and the outcome of burn injuries as discharge with complications.

Limitation of the study

This study has a number of restrictions. The first drawback is that a few variables are absent from the typical burn registration books. We are unable to determine the precise number of burn patients who were hospitalized or discharged because the data is retrospective.

Conclusion

This study demonstrates a significantly higher level of outcome for burn injuries discharged with complications, leading to increased death and other bad outcomes. Having pre-hospital intervention and the cause of burns with scalds were significant factors associated with being discharged with complications. Early fluid and electrolyte provision and having a TBS area of less than twenty percent reduce the odds for patients with a poor outcome of burn injury.

Supporting information

S1 Text Annex.

(DOCX)

S1 Data (SAV)

We would like to thank the study participants, data collectors, and supervisors who were involved in this study and spent their valuable time responding to my study.

10.1371/journal.pgph.0003682.r001
Author response to previous submission
Submission Version0
2 Aug 2023

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r002
Decision Letter 0
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version0
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PGPH-D-23-01362

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending at Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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This work is important and should be published. However, there are significant issues with the manuscript draft as raised by expert peer reviewers. Please apply all reviewer's suggestion and contributions, and review the grammar and language on the manuscript to enable publication as Plos Global Public Health does not copy edit. Applying Reviewer 1's input would be very helpful and followed by the use of Grammarly, the manuscript will be enhanced in its language. Mortality should be clearly distinguished from discharged with a complication, scarring at discharge is a normal part of burns healing and reviewers will question its veracity as a complication, and other co-morbidities and current burn protocols should be included.

Also see the attached manuscript with input to improve the text.

All changes are required. Thank you so much for this important and extensive work- looking forward to working with you to publish.

With gratitude.

==============================

Please submit your revised manuscript by Nov 12 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

1. Please provide separate figure files in .tif or .eps format only and remove any figures embedded in your manuscript file. Please also ensure all files are under our size limit of 10MB.

For more information about figure files please see our guidelines:

https://journals.plos.org/globalpublichealth/s/figures 

https://journals.plos.org/globalpublichealth/s/figures#loc-file-requirement

2. We have noticed that you have uploaded Supporting Information files, but you have not included a list of legends. Please add a full list of legends for your Supporting Information files after the references list.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I don't know

**********

3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Before being accepted for publication, the manuscript needs to be extensively revised to strengthen its language. I have provided my suggested edits for areas needing attention (highlighted in yellow). The authors may consider them during revision.

Reviewer #2: I appreciate the opportunity to review this manuscript. I applaud the authors for this study and believe it is important to understand the factors affecting outcomes of burn injuries, especially in the resource limited settings. However, I have several points of feedback:

1. Regarding patients with mortality as an outcome, it’s important to exclude them from the ‘discharged with a complication’ category. More information on these cases should be provided for both groups. Additionally, clarification is needed on what was meant by a ‘scar of skin graft,’

2. Clarification required on the assessment of burn injuries: The variables used appear to be quite broad, making it challenging to distinguish between actual complications and well-healed post-burn scars. In line 239, more information on how the researchers extracted details regarding specific complications should be provided. For instance, the variable "Did your upper extremity affected?" is mentioned, but it lacks specification regarding affected joints and range of motion. This omission would hinder the ability to determine whether a post-burn contracture, or an amputation actually occurred.

Furthermore, categorizing "scarring at discharge" as a complication might be misleading, as this is a normal part of the healing process following a burn injury.

3. The study appears limited in its consideration of comorbidities, focusing only on epilepsy. It’s essential to include other comorbidities like diabetes and heart disease, as they can significantly affect outcomes.

4. In the discussion section, it would be valuable for the authors to outline the burn treatment protocols followed at the hospitals studied. These protocols can have a substantial impact on burn outcomes.

5. The conclusion (line 292) mentions “a significantly higher level of outcome for burn injuries discharged with complications, leading to death and other worst outcomes.” The phrasing here is unclear. Please rephrase it for proper reporting.

6. Lastly, there is a need for extensive grammar editing throughout the manuscript.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Dehao Chen

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment Submitted filename: PGPH-D-23-01362_reviewer.pdf

10.1371/journal.pgph.0003682.r003
Author response to Decision Letter 0
Submission Version1
5 Dec 2023

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r004
Decision Letter 1
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version1
30 Jan 2024

PGPH-D-23-01362R1

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

A key challenge with this submission is the difficulty it presents to the reader due to the numerous grammatical errors. The authors should kindly pass the entire submission including the responses, cover letter etc through a spell check program like Grammarly https://www.grammarly.com/ This grammarly is a free version, and will greatly help improve the quality of the submission as several things are unclear in the text. In addition, if a collaborator with a English as a higher second or first language can be identified, authors can ask such a person to review the draft prior to submission. This is a challenge for many of us researchers from the Global South. Editing the text carefully will help make the manuscript more readable and less distracting for reviewers. Currently, the text is unclear, not grammatically correct, and ambiguous. Please work on this, as the world needs to hear the good work which you are doing.

Please note that all changes required by the reviewers are essential for acceptance (note reviewer's comment, and present rebuttal in Cover)- please recheck the reviewers' initial comments so as to comply. They are serving to improve the manuscript and have added in valid critique that should be incorporated.

The rebuttal should address all previous suggestions

==============================

Please submit your revised manuscript by Mar 15 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

**********

2. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: No

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: I don't know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: To evaluate this revision, a spot check was conducted for the sections before Result to assess if reviewers' comments/suggestions from the last round of review have been incorporated. While a few suggested edits/comments have been taken into account, the revision does not reflect other suggestions - the authors should explain why those comments were not taken into account. Examples of the areas without considering reviewer's suggestions were highlighted in the attachment. I highly recommend the authors consider the suggested edits that have not been adopted to improve the writing.

Further, seemingly a reviewer's comment was directly pasted to the manuscript (lines 80-82). Copyediting errors like this should be prevented.

Reviewer #2: Thank you for inviting me to review this manuscript. I commend the authors for the extensive work done to develop this interesting research.

However, I recommend that this manuscript undergo extensive English revision, preferably by an expert in scientific writing, to ensure better presentation before publication.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment Submitted filename: PGPH-D-23-01362_R1_reviewer.pdf

10.1371/journal.pgph.0003682.r005
Author response to Decision Letter 1
Submission Version2
15 Feb 2024

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r006
Decision Letter 2
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version2
22 Feb 2024

PGPH-D-23-01362R2

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Thank you for taking the time to re-edit this work. The text has substantially somewhat, but the editors still have a significant concern about the language, grammar, syntax and understandability of the text of the cover letter, responses to the reviewers, and the manuscript. I have been guided by senior editors to send back the work and refer you to a couple of potential services (not PLOS, as unfortunately we do not have one).

This paper has substance, but the key challenge is language of expression. This is understandable as the authors are not primary English speakers, but it makes for hard reading, and review (the previous reviewers are not impressed at all with the language) and this does not meet the standards for Plos Global Public Health. Previous reviewers and editors have raised this language concern over the past iterations.

Examples of their responses to the reviewers include the following, as an example:

"We are appreciating for your view and thought fully review of our manuscript. Now we are intensively and deeply amend for the reviewers comment. As much possible we are kindly correct the grammatical error and address all comments."

"We are accepted and amend it."

"We are appreciating for your view and thought fully review of our manuscript. But our outcome variable is categorical and binary; we use binary logistic regression analysis methode. And also before analysis, we checked Goodness of fitness was assessed by Hosmer-Lemeshow test & interpret in rigorously"

I think authors are doing the best you can on their own and will need some help. I have recommended Grammarly, and getting an L1 English speaker to work with the authors previously, and doubt whether this has been applied to the entire manuscript and the response. 

Suggestions from the wider editorial board

1. Here is one service aimed at LMIC authors: https://sites.google.com/umich.edu/prepss

The authors should kindly use this and submit the manuscript after editing.

2. I can also refer you to a L1, English Speaking Intern from the US who is currently working in Rwanda in Global Surgery who can help contribute to English language corrections and help you pro bono. You could email him and send an editable version of the manuscript. I have secured his commitment for 5 -6 hours during which he could work with you in the grammatical corrections before your resubmission.

We believe you should not be excluded or rejected based on language, as the science is appreciated and important.

==============================

Please submit your revised manuscript by Apr 07 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

10.1371/journal.pgph.0003682.r007
Author response to Decision Letter 2
Submission Version3
20 Mar 2024

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r008
Decision Letter 3
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version3
30 Apr 2024

PGPH-D-23-01362R3

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

The reviewers still agree that there is need for another round of copy-editing. this is the key thing standing between the manuscript and acceptance/production. Please pay attention to the cover letter and any supporting documents (previously these had not re-reviewed for language errors by the authors).

On reviewer working with you has directly requested that you add in track changes for ease of review, and I would encourage you to oblige so as to get the best out off this review process, all suggested changes are needed prior to acceptance.

==============================

Please submit your revised manuscript by May 30 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

1. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

**********

2. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: I don't know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: For revision, reviewers are looking for a version of manuscript with track changes. However, the uploaded "revised manuscript with track changes" only contains highlights without explanation. Can the authors submit the manuscript with track changes for assessment? Thanks.

Reviewer #2: I still suggest that the manuscript undergoes another extensive English editing/review before publication.

As pointed out in the previous reviews, some statements are not well put, eg. “death and other worst outcomes” under conclusions in Line 46 and Line 293

Table 3 ( line 211)-Variable “Did you use burn wound management” can be rephrased better for easy interpretation/ understanding by readers.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

10.1371/journal.pgph.0003682.r009
Author response to Decision Letter 3
Submission Version4
11 May 2024

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r010
Decision Letter 4
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version4
21 May 2024

PGPH-D-23-01362R4

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Thank you for improving the manuscript- this has moved it over 4 revisions from "Major Revisions" to "Minor Revisions". Based on repeated feedback from reviewers a lot of the challenge to the review was readability due to grammatical errors. A number of these have been addressed, but the text still contains numerous widespread grammatical errors, which makes it difficult to appropriately review.

I have discussed with an intern who has English as his first language to support you in ensuring that the text is ready (if you would like his support)- Nigel Park (nigellewis024@gmail.com). Please email him to discuss your manuscript grammatical edits. He is willing to support pro-bono. He does not work for PLoS, as the journal has no preffered editing service. I am particularly aware of the challenge for authors in LMICs where English is not the first language. This is why we have supported you thus far. Please receive this pro-bono editing service as a desire to further improve your work.

These changes will improve readability and are necessary before we can send these off to the reviewers.

For instance- the entire abstract is not clear due to grammatical incoherences.

Background: Burn injury is a major contributor to morbidity and mortality in Sub-Saharan Africa, including Ethiopia. require regular interventions???. There is limited evidence on outcome burn injury status??? in Ethiopia including the study area (specify?). Objective: To assess the outcome of burn injury and its associated factors (unclear) among burn patients attending ?a public Hospital (which one?) in North Showa zone, Ethiopia.2023 (unclear) Method: An institution-based, cross-sectional study was conducted among 420 burn patients in a public hHospital in North Showa zone, from April to May, 2023. Systematic random sampling was used to select patients’ cards???. Structured checklists were used to extract data from burn patients’ medical records. Data were entered using Epi-data EpiData version 4.6 and analyzed using SPSS version 25 variables with a p- value??? unclear of ≤ 0.25 in the bivariable logistic regression were included in the multivariable logistic regression. A p- value of ≤ 0.05 within 95% confidence interval in the multivariable logistic regression was used to declare significant association between the dependent variable and the independent variables. Adjusted odds ratio was used to show the strength of association between the dependent and independent variables. Result: In this study, 40.9% (95% CI: 36.5– 45.6) of patients were discharged with complications.  Patients who had pre-hospital intervention was nearly four times (AOR= 3.8, 95% CI, 1.11-13.25) and Patients burn with scalds was four (AOR=4.3, 95% CI, 1.52-12.32) times more (break into 2 sentences please or improve the conjunction) likely to develop discharged with complication. <Unclear Patients who had provided fluid and electrolyte were 76% and the occurrence of total body surface area burn  <Unclear etc

These issues run through out the cover letter, and throught the text, though to a lesser extent.

I have spoken with an intern with Global Surgery experience to assist in perfecting the edits pro bono (for free), and with no expectations for authorship. You can reach out to him (Nigel Park), in lieu of an editing service, on nigellewis024@gmail.com . He has agreed to take the time to carry out the language editing with you. He is a native English speaker, with English as his first language. This will be a very important first pass, as the reviewers have reached out that this makes it difficult for them to review. Please make sure to reach out to him, or use an independent professional English editing service. Plos Global Public Health does not have one, unfortunately.

You are almost there. The concepts in this paper are good and this manuscript should be published, and I will walk with you, hand in hand till we get there. I will send out to reviewers for another round of reviews once you have been able to do the additional language editing.

==============================

Please submit your revised manuscript by Jun 20 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

10.1371/journal.pgph.0003682.r011
Author response to Decision Letter 4
Submission Version5
15 Jun 2024

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r012
Decision Letter 5
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version5
19 Jun 2024

PGPH-D-23-01362R5

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised.

==============================

Warm regards and thank you for working with us to get this to publication. Kindly edit the abstract on the submission portal to match that within the manuscript. This is the abstract that the potential reviewers will see, and it is still not readable. What is in the manuscript is much improved, but the abstract (submitted on the journal portal) and the cover letter have not been changed at all. Please edit this appropriately so that I can send this out to reviewers who have expressed disfficulty comprehending the work for grammatical reasons.

Please find below unclear aspects of the abstract highlighted.

The portal abstract currently reads " Background: Burn injury is a major contributor to morbidity and mortality in Sub- Saharan Africa including Ethiopia, require regular interventions. There is limited evidence on outcome burn injury status in Ethiopia including the study area.

Objective: To assess the outcome of burn injury and its associated factors among burn patients attending public Hospital in North Showa zone, Ethiopia.2023

Method: An institution-based cross-sectional study was conducted among 420 burn patients in public Hospital in North Showa zone, from April to May, 2023. Systematic random sampling was used to select patients’ cards. Structured checklists were used to extract data from burn patients’ medical records. Data were entered using Epi-data version 4.6 and analyzed using SPSS version 25 variables with a p- value of ≤ 0.25 in the bivariable logistic regression were included in the multivariable logistic regression. A p- value of ≤ 0.05 within 95% confidence interval in the multivariable logistic regression was used to declare significant association between the dependent variable and the independent variables. Adjusted odd ratio was used to show the strength of association between the dependent and independent variables.

Result: In this study 40.9% (95% CI: 36.5– 45.6) were discharged with complication. Patients who had pre-hospital intervention was nearly four times (AOR= 3.8, 95% CI, 1.11-13.25) and Patients burn with scalds was four (AOR=4.3, 95% CI, 1.52-12.32) times more likely to develop discharged with complication. Patients who had provided fluid and electrolyte were 76% and the occurrence of total body surface area burn <20% were 66% less likely to develop the outcome burn injury discharged with complication.

Conclusion: This study demonstrates a significantly higher level of the outcome of burn injury discharged with complication, leading to death and other worst outcomes. Having pre-hospital intervention, patients with scalds burn, Early fluid and electrolyte provided and having total body surface area <20% were significant factors associated with poor outcome of burn injury. Therefore health education on pre-hospital intervention and the cause of burn and providing fluid and electrolyte for patients total body surface area affected more than twenty percent

==============================

Please submit your revised manuscript by Jul 19 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

10.1371/journal.pgph.0003682.r013
Author response to Decision Letter 5
Submission Version6
21 Jun 2024

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r014
Decision Letter 6
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version6
12 Jul 2024

PGPH-D-23-01362R6

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Thank you for your attention to the previous rounds of reviews. One reviewer is happy with the progress enough to suggest acceptance, but a few issues remain unresolved in the text and have been noted in detail by the reviewer (see attachment). Ensure to use track changes for the next (but hopefully final) round of review. Kindly address the specific comments (particularly the changes included in the draft by the second reviewer) and keep track of them using the track changes feature in the word document (not only highlighting) for clarity for the same reviewer.

Also review and clarify Lines 35-37: "Patients who received total body surface area were 20% less likely to develop discharge with complications than those who had not burned"

Line 40: “Therefore, stakeholder would more emphasis in health education on pre-hospital intervention…….”

Thank you.

==============================

Please submit your revised manuscript by Aug 11 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: I don't know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I appreciate the authors' consideration of my comments from the prior reviews. The manuscript looks much better now. However, before it being accepted for publication. There are still things that can be improved, which are listed as comments in the upload.

I'd appreciate if the authors can use track changes for the next (but hopefully final) round of review. Also, I find it challenging to open the uploaded figures. Can they be uploaded in a more common format (e.g., tiff, jpeg). Lastly, it'd be helpful to replace the long web links of some citations with DOIs of the cited articles.

Reviewer #2: I congratulate the authors and the editorial team for their tireless efforts to improve this great work. I suggest some minor edits in the abstract which still seem unclear, before publication.

-Line 35-37: "Patients who received total body surface area were 20% less likely to develop discharge with complications than those who had not burned"

Line 40: “Therefore, stakeholder would more emphasis in health education on pre-hospital intervention…….”

Congratulations, and I recommend this work to be published

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment Submitted filename: PGPH-D-23-01362_R6_comments.pdf

10.1371/journal.pgph.0003682.r015
Author response to Decision Letter 6
Submission Version7
25 Jul 2024

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r016
Decision Letter 7
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version7
6 Aug 2024

PGPH-D-23-01362R7

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PLOS Global Public Health

Dear Dr. Ayele,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Thank you for working with the review and editorial teams over the past few months. Both reviewers have now come to a point in our iteration where the team of reviewers and editors believe that this manuscript is about set for publication relative to when it was originally received. Both reviewers independently have decided that the manuscript should be accepted based on al the hard work and edits that you have put in to this work.

There are a few recommendations of one of the reviewers that still need to be addressed, as Plos global Public Health does not offer review/editing services, and there is no other point at which these minor changes requested by the reviewer can be corrected.

Below are the few final edits identified as needed before publication by the reviewer:

1. Line 36-37: Please change the sentence that says, "Patients who received total body surface area were 20% less likely to develop discharge with burn complications than those who had not burned" to ''Patients with TBSA less than 20% were 66% less likely to be discharged with complications compared to patients with TBSA greater than 20%"

2. Line 212: Steam is still a form of a scald burn. Please sub-categorize scald into ''hot liquids" and "steam" in order to keep the results and figures unaffected.

3. Line 265:Replace 21% with 20%

Once this is received and I can check to confirm that you have applied it, and then, based on the current decision of reviewers, we will let you know next steps as it will be accepted for publishing.

Thank you for your consistency and your sticking with this over the past few months.

With gratitude, 

==============================

Please submit your revised manuscript by Sep 05 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

**********

2. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: I don't know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: Congratulations to the authors, and the editorial team on the tireless efforts to make this great work much better.

Few final edits before publication:

Line 36-37: 'Patients who received total body surface area were 20% less likely to develop discharge with burn complications than those who had not burned" From your results it seems like you could change to ''Patients with TBSA less than 20% were 66% less likely to be discharged with complications compared to patients with TBSA greater than 20%"

Line 212: Steam is still a form of a scald burn. Maybe, you can sub-categorize scald into ''hot liquids" and "steam" in order to keep the results and figures unaffected.

Line 265: I think you meant 20% and not 21%?? since your categories were; below 20% and greater or equal to 20%

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

10.1371/journal.pgph.0003682.r017
Author response to Decision Letter 7
Submission Version8
8 Aug 2024

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pgph.0003682.r018
Decision Letter 8
Alayande Barnabas Tobi Academic Editor
© 2024 Barnabas Tobi Alayande
2024
Barnabas Tobi Alayande
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version8
15 Aug 2024

Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study

PGPH-D-23-01362R8

Dear Mr Ayele,

We are pleased to inform you that your manuscript 'Outcome of Burn Injury and its Associated Factors among Burn Patients Attending Public Hospitals in North Showa Zone, Ethiopia: A Cross-Sectional Study' has been provisionally accepted for publication in PLOS Global Public Health.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they'll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact globalpubhealth@plos.org.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Global Public Health.

Best regards,

Barnabas Tobi Alayande

Academic Editor

PLOS Global Public Health

***********************************************************

All required changes have been performed.

Thank you for this much improved work over the past few months. In my reflections, I congratulate the authors for sticking with the process in a determined and focussed manner, the reviewers for their selfless intentionality and determination not to focus on certain perceived limitations but on scholarly content, and PLOS Global Public Health for equity-driven and thoughtful journal policies that make it possible for publications like this, with merit, to be published. Great job, and hard work, all 8 revisions later.

The English language limitations of non L1/primary speakers is too often a stumbling block to publication. This should not be, and even though this road was hard and long, we have shown what is possible even without an editing service. We are not saying this is perfect work, we are saying it meets the criteria for publication in PlosGPH and the authors should be proud of the iterative, but gratifying process. As you go through the next required changes, please reflect on the fact that your reviewers and editors have walked this path together, on the same team, to bring forward this very important piece that is of improved quality and relevant to burns on the African continent.

Congratulations all!

Reviewer Comments (if any, and for reference):
==== Refs
References

1 Figueiredo BT Utsunomiya FK Ribas Rosa de Oliveira MA , Pires-Neto CR , Tanaka C , Mobilization practices for patients with burn injury in critical care. Burns, 2020. 46 (2 ): p. 314–321. doi: 10.1016/j.burns.2019.07.037 31466922
2 Vermaak VP , Federica DA , Jake DA , Matthew F , Yvonne TW , Thromboprophylaxis in adult and paediatric burn patients: a survey of practice in the United Kingdom. Burns, 2019. 45 (6 ): p. 1379–1385. doi: 10.1016/j.burns.2019.04.003 31079961
3 Biru A , Jemebere W ; Mekonnen , Tadesse F , Epidemiology and outcome of childhood burn injury in Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Indian Journal of Burns, 2020. 28 (1 ): p. 51. 10.1177/23779608231186864
4 Heydarikhayat N Ashktorab T , Rohani C , Zayeri F , Effect of post-hospital discharge follow-up on health status in patients with burn injuries: a randomized clinical trial. International journal of community based nursing and midwifery, 2018. 6 (4 ):. google.com/search=Heydarikhayat%2C+N.%2C+et+al.%2C+Effect+of+posthospital+discharge+followup+on+health+status+in+patients+with+burn+injuries%3A+a+randomized+clinical+trial.+International+journ.
5 Karlie J and Wardhana AM External Validation of Belgian Outcome of Burn Injury Score on Burned Patient In Burn Unit dr. Cipto Mangunkusumo General Hospital. The New Ropanasuri Journal of Surgery, 2017. 2 (1 ): p. 3. google.com/search?q=Karlie%2C+J.+and+A.+Wardhana%2C+External+Validation+of+Belgian+Outcome+of+Burn+Injury+Score+on+Burned+Patient+In+Burn+Uni t+dr.+Cipto+Mangunkusumo+General+Hospital.+The+New+Ropanasuri+Journal+of+
6 Theodorakopoulou E , Goutos L , Mason K , Ghanem MA , Myers S , London calling Gaza: The role of international collaborations in the globalisation of postgraduate burn care education. Scars, Burns & Healing, 2019. 5 : p. 2059513119830519. doi: 10.1177/2059513119830519 30815281
7 Tupper C. and A Doyal OSHA Fire Safety, in StatPearls [Internet]. 2022, StatPearls Publishing.https://www.google.com/search?q=Tupper%2C+C.+and+A.+Doyal%2C+OSHA+Fire+Safety%2C+in+StatPearls+%5BInternet%5D.+2022%2C+StatPearls+Publishing.&sca_esv=f42f57a008774f06&sca_upv=1&sxsrf=ADLYWIJY8SRlUsjgfUE6dPX09DqQufcFtA%3A1715361733908&ei=xVcZuH0NrOM9u8P
8 Gonçalves N , Ciol AM , Spadoti Dantas AR , Farina Junior AJ , Rossi AL , A randomized controlled trial of an educational programme with telephone reinforcement to improve perceived health status of Brazilian burn victims at 6‐month post discharge. Journal of Advanced Nursing, 2016. 72 (10 ): p. 2508–2523. doi: 10.1111/jan.13003 27189899
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